The relationship between bone mineral density and blood pressure in the Korean elderly population: the Korea National Health and Nutrition Examination Survey, 2008-2011.

It is not clear whether the inverse relationship between bone mineral density (BMD) and blood pressure (BP) could be generalizable to the general elderly population. We used data from the fourth and fifth Korea National Health and Nutrition Examination Survey. The study sample consisted of 8439 men and postmenopausal women aged 50 years and older. We evaluated the relationship between BMD and BP. When adjusted for covariates, femur neck T-score [coefficient = -0.391, 95% confidence interval (CI) -0.766 to -0.016, p = 0.041] had an inverse relationship with diastolic BP (DBP), whereas lumbar spine BMD (coefficient = 0.395, 95% CI 0.058-7.752, p = 0.047) and T-score (coefficient = 0.458, 95% CI 0.005-0.911, p = 0.047) had a positive relationship with systolic BP (SBP). When adjusted for confounding factors, SBP (128.67 ± 0.979 mmHg versus 126.36 ± 0.545 mmHg, p = 0.026) and DBP (78.8 ± 0.622 mmHg versus 77.27 ± 0.283 mmHg, p = 0.016) were significantly higher in femur neck osteoporosis subjects than non-osteoporosis subjects. However, there were no differences in BP in relation to lumbar spine osteoporosis. Femur neck osteoporosis (odds ratio = 1.422, 95% CI 1.107-1.827, p = 0.006) had a significant and positive relationship with hypertension, whereas the other parameters of BMD were not significantly related to hypertension. In conclusion, higher BP and hypertension were significantly and positively correlated with femur neck osteoporosis in men and postmenopausal women aged 50 years and older.

Relationship between bone mineral density and a 10-year risk for coronary artery disease in a healthy Korean population: the Korea National Health and Nutrition Examination Survey 2008-2010.

INTRODUCTION: Bone mineral density (BMD) is associated with atherosclerosis and vascular calcification. If BMD is related independently to the risk of coronary heart disease (CHD), BMD could play an important role in CHD risk prediction. We assessed the hypothesis that BMD is related independently to the risk of CHD. MATERIALS AND METHODS: We used data from the fourth and fifth Korea National Health and Nutrition Examination Surveys. The study sample included men and women aged 20-79 years, who did not have myocardial infarction, angina pectoris, stroke, or diabetes mellitus. We evaluated the relationship between BMD and the Framingham risk score for each sex. RESULTS: In the male population, femur neck BMD [coefficient=-2.167, 95% confidence interval (CI) -3.385 to -0.950, P=0.001] and lumbar spine BMD (coefficient=-1.539, 95% CI -2.546 to -0.532, P=0.003) showed an inverse correlation with the Framingham risk score after adjusting for covariates. In the female population, the relationship between BMD parameters and the Framingham risk score was not significant after adjusting for covariates. In the male population, those with femur neck BMD values in the first quartile had greater odds of a 10-year risk greater than or equal to 10% for CHD compared with those in the fourth quartile (odds ratio=1.942, 95% CI 1.315-2.869, P<0.001). CONCLUSION: BMD was correlated inversely with the 10-year risk for CHD in the healthy male population. This result suggests that in the male population, measurement of BMD could be useful for prediction of the risk of CHD.

Health-related quality of life in coronary heart disease in Korea: the Korea National Health and Nutrition Examination Survey 2007 to 2011.

Using data from 2007 to 2011 of the Korea National Health and Nutrition Examination Survey, we evaluated the influence of coronary heart disease (CHD) on health-related quality of life (HRQoL) as measured by the EQ-5D in comparison with the general population and the predictors of HRQoL in CHD. Compared with the general population, HRQoL was impaired in the EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression. The impairment of HRQoL was much greater in the older age group and in females. In subjects with CHD, the predictors for a low EQ-5D index were old age, female sex, low education, stroke, and noncardiovascular comorbidities, and the predictors for a low EQ Visual Analogue Scale were low income and noncardiovascular comorbidities. For the improvement in HRQoL, preventing stroke and noncardiovascular comorbidities is important, especially among female and older Asian patients with CHD.

Type 2 myocardial infarction following generalized tonic-clonic seizure.

Myocardial infarction is diagnosed when blood levels of biomarkers are increased in the clinical setting of acute myocardial ischemia. Among the biomarkers, troponin I is the preferred biomarker indicative of myocardial necrosis. It is tissue specific for the heart. Myocardial infarction is rarely reported following seizure. We report a case of elevated troponin I in a patient after an episode of generalized tonic-clonic seizure. The diagnosis was type 2 myocardial infarction.

Effects of granulocyte-colony stimulating factor (G-CSF) on diabetic cardiomyopathy in Otsuka Long-Evans Tokushima fatty rats.

BACKGROUND: Diabetic cardiomyopathy (CMP) is a common and disabling disease in diabetic patients, however no effective treatments have been developed. Although granulocyte-colony stimulating factor (G-CSF) improves heart function in myocardial infarction, its effect on non-ischemic CMP such as diabetic CMP is unknown. In the present study, we investigated the effects of G-CSF on diabetic CMP in a rat model of type II diabetes. METHODS: Twenty 7-week-old male Otsuka Long-Evans Tokushima Fatty (OLETF: a rat model of diabetes) rats and 10 male Long-Evans Tokushima Otsuka (LETO: normal controls) rats were used. All of the LETO and 8 OLETF rats were fed on tap water while the rest were fed on sucrose-containing water. After 10 weeks, saline or recombinant human G-CSF (100 µg/kg/day) was injected intraperitoneally for 5 days. Blood levels of glucose, total cholesterol and triglyceride, and Doppler echocardiograms for diastolic dysfunction were obtained just before and 4 weeks after the saline or G-CSF treatment. Light microscopy, electron microscopy (EM) and immunohistochemistry for transforming growth factor-ß were employed to examine myocardial histology 4 weeks after the saline or G-CSF treatment. RESULTS: Diastolic dysfunction developed at 17 weeks (before the saline or G-CSF treatment) in the OLETF rats whether or not they were fed sucrose water, but were more severe in those fed sucrose water. Four weeks after saline or G-CSF treatment, diastolic function had recovered in the G-CSF-treated group regardless of sucrose water feeding, and perivascular and/or interstitial fibrosis in the G-CSF-treated group had decreased significantly. TGF-ß immunoreactivity in the interstitial and perivascular tissue was also reduced in the G-CSF-treated group, and EM studies revealed less severe disruption of myofilaments and mitochondrial cristae, and decreased collagen deposition. CONCLUSIONS: G-CSF can ameliorate cardiac diastolic dysfunction and morphological damage, especially fibrosis of the myocardium, in OLETF rats with diabetic CMP.

The relationship between ambulatory arterial stiffness index and blood pressure variability in hypertensive patients.

BACKGROUND AND OBJECTIVES: Ambulatory arterial stiffness index (AASI) is well known as a predictor of cardiovascular mortality in hypertensive patients. Mathematically, AASI reflect the standard deviation (SD) of blood pressure (BP) variation. AASI is measured higher levels in non-dipper than dipper. Thus, AASI has a possibility of not only reflecting arterial stiffness but also BP variability and/or autonomic nervous dysfunction. SUBJECTS AND METHODS: Consecutive data from 418 untreated hypertensive patients were analyzed retrospectively. We examined the association between the 24-hour ambulatory BP monitoring (ABPM) parameters and AASI. RESULTS: AASI had a simple correlation with age (R=0.189, p<0.001), relative wall thickness (RWT) (R=0.115, p=0.019), left ventricular mass index (LVMI) (R=0.192, p<0.001), average systolic BP (SBP) (R=0.232, p<0.001), average pulse pressure (PP) (R=0.363, p<0.001), SD of diastolic BP (DBP) (R=-0.352, p<0.001), SD of PP (R=0.330, p<0.001), SD of heart rate (HR) (R=-0.268, p<0.001), and nocturnal dipping (R=-0.137, p=0.005). In multiple linear regression analysis model including clinical parameters and 24 hour-ABPM parameters, independent predictors of AASI were SD of PP (ß=1.246, p<0.001), SD of DBP (ß=-1.067, p<0.001), SD of SBP (ß=-0.197, p<0.001), and non-dipper (ß=0.054, p=0.033). CONCLUSION: AASI is closely correlated with BP variability. The result of this study shows that AASI is not only a parameter for arterial stiffness, but also a parameter for BP variability.

Non-Dipper Pattern is a Determinant of the Inappropriateness of Left Ventricular Mass in Essential Hypertensive Patients.

BACKGROUND AND OBJECTIVES: Inappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass. SUBJECTS AND METHODS: Using the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day. RESULTS: Daytime, nighttime and 24 hours BP in hypertensive patients was 140.4±14.8 mmHg, 143.7±15.2 mmHg and 129.4±20.0 mmHg, respectively. OPR was 106.3±19.9% and nocturnal dipping was 10.2±10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (ß=0.097, p=0.043) and nocturnal dipping (ß=-0.098, p=0.046) were independent determinants of OPR as well as age (ß=0.130, p=0.025) and body mass index (BMI) (ß=0.363, p<0.001). Odds ratio of the non-dipper pattern was 2.134 for iLVM (p=0.021) and 3.694 for obesity (p<0.001; BMI >25 kg/m(2)). CONCLUSION: The non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.

Recurrent infective endocarditis associated with pyogenic spondylodiskitis.

Infective endocarditis is a life-threatening condition caused by microbial infection of the heart's endocardial surface. This condition can also be associated with bacterial infections of other organs. We experienced an unusual case of recurrent infective endocarditis associated with pyogenic spondylodiskitis. A 70-year-old man presented with persistent fever and lower back pain visited our hospital. The patient had a past history of recurrent infective endocarditis. He was diagnosed with infective endocarditis again based on clinical symptoms and echocardiographic findings. Magnetic resonance imaging was used to evaluate lower back pain, which showed acute spondylodiskitis on L3 and L4 vertebrae. The patient completely recovered following four weeks of antibiotic therapy.

Development of acute myocardial infarction in a young female patient with essential thrombocythemia treated with anagrelide: a case report.

Essential thrombocythemia (ET) is a chronic myeloproliferative disorder with a prolonged clinical course. Since this disorder is considered to be at increased risk of thromboembolism, therapy is mainly focused on the decreased risk of thrombohemorrhagic events by use of cytotoxic agents. Anagrelide is a phosphodiesterase III inhibitor which is utilized in the treatment of ET for the reduction of platelets. However, patients treated with anagrelide might experience cardiovascular adverse effects including myocardial infarction (MI), although these events are rare. Herein, we report a case of a 30-year-old female with well controlled ET by anagrelide, who eventually developed an acute non-ST elevation myocardial infarction (MI). There has no found any cardiovascular risk factors in this ET patient, strongly suggesting that anagrelide might be the cause of MI. Therefore, cardiovascular function should be monitored in those patients prescribed with anagrelide.

Bone Mineral Density is an Independent Determinant of Left Ventricular Mass Index in the General Female Population.

BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH) is a well known cardiovascular prognostic predictor. Osteoporosis has been suggested to be associated with cardiovascular disease. According to studies of primary hyperparathyroidism, a pathophysiological association between calcium metabolism and LVH has been suggested but is not yet fully understood. This study was performed to investigate the association between bone mineral density (BMD) and left ventricular mass index (LVMI) in a general population. SUBJECTS AND METHODS: Data from 460 subjects among 543 subjects sampled from a general population in a rural area in Korea were analyzed. BMD, echocardiography, brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (IMT) measurement as well as the measurements of blood pressure, blood chemistry and metabolic parameters were analyzed. BMD was measured using the Sahara Clinical Bone Sonometer (Hologic Inc., Mass., USA). RESULTS: Age of the subjects was 59.4±12.4 years. Males were 42.2% (n=194). In a simple correlation analysis on female subjects, age and waist circumference showed negative correlation, and body mass index (BMI) showed positive correlation with BMD. However, only age showed negative correlation with BMD in male subjects. After adjusting baPWV and carotid IMT, we found that BMD was an independent determinant of LVMI in female subjects (ß=-13.703, p=0.016), but not in male subjects (ß=-1.235, p=0.841). CONCLUSION: BMD is a consistent and independent determining factor of LVMI, BMI and carotid IMT in postmenopausal women.

Association between inappropriateness of left ventricular mass and left ventricular diastolic dysfunction: a study using the tissue Doppler parameter, e/e'.

BACKGROUND AND OBJECTIVES: The structural significance of the inappropriateness of left ventricular mass (iLVM) is known to be an important prognostic factor for cardiovascular events; however, the functional changes associated with iLVM have not been established. This study was performed to determine if diastolic dysfunction is associated with iLVM using a tissue Doppler technique. SUBJECTS AND METHODS: Three hundred sixty consecutive subjects, including 221 hypertension patients from the echocardiography database, were analyzed. Regarding the appropriateness of left ventricular (LV) mass, an observed/predicted ratio of LV mass (OPR) >130% was defined as inappropriate. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), isovolumetric relaxation time (IVRT), and E/early mitral annulus velocity (E'), were compared between the appropriate LV mass (aLVM) group and the iLVM group. RESULTS: Among transmitral flow parameters, only the E velocity was negatively correlated with the OPR when adjusted for age (adjusted r=-0.107, p=0.04). Based on multiple regression analysis, the OPR (beta=0.163, p=0.003), as well as age (beta=0.286, p=0.0001), systolic blood pressure (beta=0.120, p=0.019), fasting blood glucose (beta=0.098, p=0.042), and male gender (beta=0.157, p=0.002) were independent factors determining E/E'. The cholesterol level was not an independent factor (beta=-0.059, p=0.355). In the iLVM group (n=105), the adjusted E/E' was higher than in the aLVM group (n=255; 11.7+/-3.4 vs. 10.8+/-3.1, p=0.02), while the peak E flow velocity was significantly lower than in the aLVM group (70.9+/-15.1 vs. 75.5+/-17.6, p=0.03). CONCLUSION: Inappropriateness of LV mass is independently associated with increased E/E'. Thus, E/E' may be a useful parameter for the evaluation of diastolic dysfunction.

Influence of abdominal circumference on the inappropriateness of left ventricular mass and diastolic function in non-obese patients.

BACKGROUND AND OBJECTIVE: Adipose tissue may be one of the sources of the humoral factors increasing left ventricular mass (LVM) via non-hemodynamic mechanisms. The involvement of visceral obesity in excessive or inappropriate LVM has not been established. We investigated the effect of abdominal circumference on the inappropriateness of LVM in non-obese patients. METHODS: Echocardiographic parameters for LVM and the indices for diastolic function were analyzed in 312 non-obese patients. Inappropriate LVM was defined as observed/predicted ratio (OPR) of LVM > 130%. Predicted LVM was calculated by the equation of 54.9 + 7.62 x height (m(2.7)) + 0.67 x stroke work--13.2 x sex (male = 1, female = 2). Abdominal obesity was defined by abdominal circumference > 80 cm in females and > 90 cm in males. RESULTS: Multiple regression analysis showed abdominal circumference was a significant factor for OPR of LVM (beta = 0.256) which was independent of age (beta = 0.215), sex, systolic blood pressure (beta = -0.232), body mass index (beta = 0.232), and fasting blood glucose (beta = 0.146). Odds ratio (OR) of abdominal obesity for inappropriate LVM was 3.28 (1.72-6.28), which was independent of age > or = 55 [OR: 2.17(1.11-4.25)], body mass index > or = 22.5 kg/m2 [OR: 2.24(1.13-4.41)], and diabetes mellitus [OR: 2.27 (1.06-4.85)]. Age and sex adjusted abdominal circumference (86.4 +/- 0.9 vs 82.1 +/- 0.5), abdominal obesity (28.1% vs 54.1%), and metabolic syndrome (19.4% vs 51.6%) were higher in the inappropriate LVM group than the appropriate LVM group (p < 0.001). CONCLUSIONS: Abdominal obesity or the presence of metabolic syndrome is an important factor to predict the inappropriateness of LVM even in non-obese patients.

[The resting electrocardiographic ST segment depression and related factors at a rural adult community, Korea].

OBJECTIVES: To measure the distribution of electrocardiographic ST segment depression, and evaluate its relationships with cardiovascular risk factors based on the cross-sectional studies within a rural Korean community. METHODS: This study analyzed 1,343 persons, over 40 years old, who participated in a baseline survey during 2002-2005; the exclusion criteria included: a past history of myocardial infarction and angina pectoris, and specific conduction abnormalities. A Standard 12 leads ECG was recorded using an FCP-2101 (Fukuda Denshi Co.). The ST segment depression was retrospectively measured by a physician, according to the Minnesota code classification. RESULTS: ST segment depression was found in 3.6 and 6.4% of male and female participants, respectively. After adjusting for age, gender, smoking, physical activity and obesity differences, high blood pressure showed significant relations with ST depression in females (male ORs=2.67, 95% CI=0.85-8.50; female ORs=2.62, 95% CI=1.29-5.32) CONCLUSIONS: As an ischemic ECG sign, ST depression was related to hypertension in female participants. This relationship remained significant, even after cases with left ventricular hypertrophy were removed.

Accidental ten times overdose administration of recombinant human erythropoietin (rh-EPO) up to 318,000 units a day in acute myocardial infarction: report of two cases.

The cytokine erythropoietin protects the heart from ischaemic injury, in part by preventing apoptosis. But appropriate dose of erythropoietin for the protection of injured heart has not been studied. While we were researching the cardiac protective effects of erythropoietin in acute myocardial infarction, we experienced two cases of accidental nearly ten times overdose administration of erythropoietin up to 318,000 units instead of 33,000 units on the second day of three scheduled days of treatment. So a total of 384,000 units of erythropoietin were administered during three days. In case 1, the ALT level soared up to 386 U/l on the second day of administration and decreased slowly. It was back to normal state 3 months later. The AST level increased slowly up to 391 U/l and normalized 3 months later. Haemoglobin level was elevated up to 15.7 g/dl (14.7 g/dl at admission) and, 3 months later, normalized to 14.8 g/dl. In case 2, the ALT level was elevated up to 98 U/l on the second day of administration and decreased slowly. Three months later, the ALT level was normalized. The AST level also increased slowly up to 71 U/l and normalized 3 months later. Haemoglobin level was elevated up to 15.6 g/dl (13.8 g/dl at admission) and, 3 months later, normalized to 13.6 g/dl. In these two cases reported, these patients, even after massive overdose, tolerated it relatively well and the only side-effects we found were elevated liver enzyme and haemoglobin levels.